What is the treatment for Temporomandibular Joint (TMJ) arthritis?

Treatment for Temporomandibular Joint (TMJ) Arthritis

The optimal treatment for TMJ arthritis should begin with conservative approaches including education, self-management strategies, and pharmacological therapy, with more invasive interventions reserved for refractory cases. 1

Initial Conservative Management

Self-Management and Education

• Jaw rest and behavioral modifications
• Soft diet to reduce joint stress
• Application of heat and/or cold for pain relief
• Avoiding wide mouth opening or aggravating activities
• Patient education about the condition and its typically self-limiting nature

Pharmacological Management

• Short-term NSAIDs for acute pain management
• Paracetamol (acetaminophen) as an alternative for patients who cannot tolerate NSAIDs
• Tricyclic antidepressants for chronic pain with sleep disturbances
• Glucosamine sulfate has shown effectiveness for TMJ pain (71% improvement compared to 61% with ibuprofen) 1

Physical Therapies

• Manual therapy
• Supervised exercises
• Massage therapy

Dental Interventions

• Occlusal splint therapy, particularly beneficial for patients with bruxism 1
• Minor occlusal equilibration if indicated

Advanced Interventions for Refractory Cases

Intra-Articular Interventions

• For skeletally mature patients with active TMJ arthritis and persistent orofacial symptoms:

  • Intraarticular glucocorticoid injection may be indicated 2, 1
  • Intraarticular lavage (without steroid) may be effective 1

• For skeletally immature patients:

  • Intraarticular glucocorticoid injection is NOT recommended as first-line treatment 2
  • May be used cautiously only in patients with refractory TMJ arthritis and orofacial symptoms
  • Repeated glucocorticoid injections are not recommended 2

Surgical Interventions

• Reserved as a last resort after exhausting all conservative options 1, 3
• Options include:
  • Arthrocentesis
  • Arthroscopy
  • Open surgery of the TMJ
  • Total TMJ replacement (for joint collapse or fusion) 3

Special Considerations for Juvenile Idiopathic Arthritis (JIA)

• Systemic immunosuppressive therapy has shown beneficial effects on TMJ arthritis, mandibular growth, and progression of TMJ deformity 2
• Early and aggressive systemic treatment is recommended to reduce TMJ arthritis-related sequelae 2
• Regular monitoring of facial morphology and TMJ function is essential 2

Monitoring and Follow-up

• Regular reassessment to monitor treatment effectiveness
• Standardized approach to physical examination including:
  • Range of motion assessment
  • Palpation of masticatory muscles and TMJ
  • Assessment of joint sounds
  • Evaluation for dentofacial deformities 1

Important Caveats

• Up to 50% of TMJ disorder patients may not require any intervention as symptoms can be self-limiting within one year 1
• TMJ retains capacity to repair and remodel throughout life, supporting conservative management in most cases 4
• Poor prognostic features include involvement of multiple joints, presence of erosive disease, elevated inflammatory markers, and delayed diagnosis 1
• Skeletally immature patients require special consideration due to potential growth effects of certain treatments 2
• Steroid injections should be used with caution, especially in younger patients, due to potential side effects 2, 5